Weighing Patient Preferences: Lessons for a Patient Preferences Predictor

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This article refers to:

A Personalized Patient Preference Predictor for Substituted Judgments in Healthcare: Technically Feasible and Ethically Desirable

Notes

1 As Earp et al. (2024) emphasize, there are many ways to build a PPP. My comments will apply broadly, so I will stick with this generic construal. But it is worth noting here at the outset that, if feasible, some version of Earp et al.’s “Personalized Patient Preference Predictor” (P4) will likely be best positioned to both realize the benefits and minimize the risks that I discuss in what follows.

2 In setting these concerns aside I do not mean to suggest that they lack force; some highlight serious challenges for the development and general use of PPPs. Here, however, my focus is on risks and benefits of implementation that must be grappled with even assuming the more global challenges can be addressed.

3 For a canonical discussion of what is often called the “substituted judgment standard,” see Buchanan and Brock (1989).

4 There is considerable disagreement about how to characterize the hypothetical relevant to the substituted judgment standard. See Broström et al. (2007) and Stout (2022) for helpful discussions.

5 Here one might object that there is no reason to respect the autonomy of such agents because such agents are non-autonomous. But the standards of ideal autonomy are lofty and rarely met by actual agents; so if failing to conform to the standards of ideal autonomy rendered an agent non-autonomous, then the reason to respect autonomy would rarely arise. To account for the ubiquity of the reason to respect autonomy, then, we must recognize that autonomy comes in degrees and that the reason to respect autonomy is relevant to the treatment of non-ideally autonomous agents.

6 See Wasserman and Navin (2018) and Schwan (2022) for discussions of the moral relevance of incapacitated patients’ expressed preference.

7 See Gerrek (2018) for an insightful discussion of the case of Andrea Rubin, whose preferences and values transformed after a significant burn injury.

8 See Moore et al. (2022) for a helpful taxonomy of patient ambivalence and Raskoff (2022) for discussion of incommensurable values and hard choices in the clinical setting.

9 Earp et al.’s P4 seems especially promising on this score.

10 See Enoch (2017) for a thorough defense of this claim.

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